Gunilla Glad Mattsson

Renal preservation in children with neurogenic bladder-sphincter dysfunction followed in a national program.

PURPOSE Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines. MATERIALS AND METHODS Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth. RESULTS Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P < 0.01). Most children with renal scars (4/5) had a combination of low compliant bladder and insufficient compliance with treatment and follow up. CONCLUSION High baseline pressure is confirmed as a risk factor that, in combination with complex social issues, creates a demanding situation for families and professionals. A structured early follow up with treatment compliance effectively prevents renal damage.

Children and youth with myelomeningocele's independence in managing clean intermittent catheterization in familiar settings

Aim:  To examine the ability of children and youth with myelomeningocele to independently manage clean intermittent catheterization.

Voiding school for children with idiopathic urinary incontinence and/or bladder dysfunction.

OBJECTIVE Individually applied urotherapy is first-line treatment in children with bladder dysfunction. A new concept of treatment for small groups of children was applied and evaluated. PATIENTS AND METHODS Two hundred children, 116 of them girls, aged 3-14 years (median 7.2) with bladder dysfunction and incontinence received urotherapy in small groups (2-5), called voiding school (VS). Outcome was evaluated after 3 and 12 months by voiding/leakage diary and questionnaire, and at 3 months by uroflow and post-void residual urine as well. RESULTS The outcome of VS was independent of age and gender. At follow up at 3 and 12 months, respectively, 35% and 40% of the children were cured and another 30% and 34% improved (P≤0.0001). Compared with the year before start of VS, urinary tract infections decreased from 34% to 6% (P<0.0001). Median residual urine decreased from 15 ml before VS to 6 ml after 3 months (P<0.001). CONCLUSION The concept of VS is a good alternative to individual urotherapy, with the outcome of fewer urinary tract infections and improved continence. Urotherapy for groups of children compared to individual treatment is also expected to have financial benefits.

Children and Youth with Myleomeningocele's Independence in Managing Clean Intermittent Catheterization in Familiar Settings

Aim:  To examine the ability of children and youth with myelomeningocele to independently manage clean intermittent catheterization.

Independence does not come with the method--treatment of neurogenic bowel dysfunction in children with myelomeningocele.

The aim was to evaluate and compare different bowel regimes with regard to satisfaction, faecal incontinence and independence, and the relationship to quality of life among children with myelomeningocele (MMC).

Spend a penny independent - a multidisciplinary project

Background Today children with long-lasting state of illness including children with myelomeningocele (MMC) reach adulthood to an entire larger extent than before and will set an entitled requirement on participation in the society. A mapping of treatment regimes for children with neurogenic bladder and bowel disturbances shows that independence in the toilet situation is quite rare despite intensive actions at the hospital and that incontinence is common. A multidisciplinary project to evaluate the obstacles to independence in the toilet situation has been running. The general aim was to develop a strategy, based on the outcome of four of altogether nine studies, to give a possibility for the growing child to gradually take responsibility for itself that may create improvement in quality of life, decrease in costs for continence aids, assistance and healthcare.

Effectiveness and independence - different treatments of neurogenic bowel dysfunction in children with myelomeningocele

Background Constipation is a major problem in children with myelomeningocele and may result in a range of problems from impaired growth to faecal incontinence. Treatment regimes differ between countries and comparisons between the different methods are rare. Apart from effectiveness aspects as time needed and factors related to possibilities of independence are also important. Dominating treatment regimes are oral laxatives, transrectal irrigation (TRI) and different kinds of irrigation via appendicostomy.